Question: If the urologist performs an ESWL for a stone in the right ureter and a separate stone in the right renal pelvis, can I report 50590 and 50590-XS?
Answer: Since recent CPT® coding rules consider the renal pelvis and ipsilateral ureter as separate organs, the most correct coding may be 50590 (Lithotripsy, extracorporeal shock wave) and 50590 with modifier XS (Separate structure) appended. That’s because you’re billing for both procedures on the same side, but in different organs.
Not so fast: Remember, however, that on occasion, some insurers might deny one of the same CPT® codes used. According to the situation described above, reporting the same procedure code for two stones in different locations should not be denied, and an appeal certainly would be in order. By contrast, you should only report 50590 once when the urologist performs ESWL to treat multiple stones in one organ (either within the ureter or kidney).